DEPARTMENT OF THE ARMY
SEVENTH BRIGADE, US ARMY CADET COMMAND
UNIVERSITY OF LOUISVILLE
DOUGHERTY HALL ROOM 214
2301 SOUTH THIRD STREET
LOUISVILLE, KENTUCKY 40292
REPLY TO
ATTENTION OF:
ATCC-GGK-YUL
Date:
MEMORANDUM FOR Professor of Military Science
SUBJECT: Statement of Acknowledgement for Civilian Dental Records
_______ I have verified with my dentist that my dental records do contain descriptive profiles,
bite wing x-rays, orthodontic profiles or dental x-rays for identification purposes.
Dentist Name: ____________________________________ Phone: ______________________
Address: _________________________________________
_________________________________________
_________________________________
(CADET PRINT NAME)
_________________________________
(DATE)
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(CADET SIGNATURE)